Interdisciplinary Plan of Care and Patient Education

8/14/2019 Interdisciplinary Plan of Care and Patient Education

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NTERDISCIPLINARY PLAN OF CARE AND PATIENT EDUCATION RECORD pg 4 of 5

Transporter Training Handout

Adm Dx:

NONRE-BREATHER O2 MASK VENT PT ON MONITOR MONITOR

65yo Fe CT Abd ICU or Renal scan Cardiac Cath or Stress Test

Nurse

IVF

How will this ON

one be transported? 15

Change toO2 4l NC Can You take pt yourself? Why

pt refuses O2

How will this one be transported? Change senario to Telemetry

Can You take pt yourself? Why7

How will this one be transported? & IVF??

FALL/ELOPEMENT/RESTRAINTS Handoff Communication Detail Focus: Other Date Sched

PCU pt Support Needs Situation/Procedure:

young male going for STAT CT Head

green arm band on ??? & also Personal Needs

he yells

out _____________________

Safety Needs

IR PT___ INR____ PTT____ date_____

How will this one be transported? Physical Needs: Transport Via

Does he need anything else before? ______________

Handoff Communication Detail

DEAF DOES NOT KNOW ABOUT TEST/OR Transport process using SBAR 3 MONTH OLD CXR/F&U ABD

(circle as appropriate) Handoff communication requires signature

1) when picking up patients go to chart first, it

ALWAYS should go with patient

2) IN CHART TO MULTIDISCIPLINARY

3) transport per these instructions, if blank or

seems innacurate ask nurse/chg nurse

How will this one be transported? and for what you are taking them How will this one be transported?

Teaching Method Response Date/Initial Teaching Method Response pt returns LEGENDontrast dye 1 2 3 4 P/F 1 2 3 4 P/F complete upon admissicomplete at dis

MRI 1 2 3 4 P/F 1 2 3 4 P/F Method:

CT scan 1 2 3 4 P/F 1 2 3 4 P/F

NPO 1 2 3 4 P/F 1 2 3 4 P/F Response:

Colon Prep 1 2 3 4 P/F 1 2 3 4 P/F

tress Trest 1 2 3 4 P/F 1 2 3 4 P/F

Hold Metformi 1 2 3 4 P/F 1 2 3 4 P/F

Date Signature/Discipline Initals Date Signature/Discipline Initals

Allergic to contrast dye: ___Yes ___No Use for:procedure off unit/req.prep/traumatic/Inho

TRANSPORT

ituation/Procedure: Situation/Procedure:NRB 100% NURSE MONITOR VENT wheelchair

stretcher stretcher

O2 4LPM NC

stretcher

ituation/Procedure: with contr

wheelchair Telemetry Transport Monitor O2 @________ IR guided biopsy needle aspirat

Nurse Vent _____________________

Nuc MedHIDA scan

Deaf Blind HOH Background (Dx/Hx/symptoms r/t situLanguage Barrier_______________________ pain____

HIDA scan no pain meds/ 8hrs p

Fall Precautions Restraints Assessment: If with contrast Bun___

Confused Elopement (may wander)

(init)___correct pt ___correct prep ___co

Wheelchair parent lap Recommendation critical value__

stretcher/bed Pt tol exam: well refused poor needs

complete return @_____ini/date

Situation/Procedure: Situation/Procedure:

Deaf wheelchair

TAB, OPEN TO THIS PAGE OF POC (PLAN OF Care)

to fill it in DO NOT TAKE PT TIL FILLED IN

4) Nurse or Chrg Nurse must sign correct pt/prep/test

before pt can go you MUST know to where

5) tech/nurse in dept must check complete or retrun BEORE

1= Verbal/1:12=Demonstrat

3=Written Material4= Audio/Vis

=Patient F=Fam

A=Asked questionsReturn Demonstrates

B=Poor AttentionN=Needs Reinforceme

D=Verbalizes UnderstandingC=Denial/Res

Teaching Goals: P or F is able

ImImSickSickSamSam


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INTERDISCIPLINARY PLAN OF CARE &

update Q 24 hours PATIENT/FAMILY EDUCATION RECORD update Q 24 hourSection I) PATIENT EDUCATIONAL NEEDS ASSESSMENT (circle appropriate responses

Readiness to learn: Support System: Preferred Method:

K 1 2 3 4 5 6 7 8 9 10 11 12 Technical/Vocational spouse family Verbal (1:1) Written Video

College 1 2 3 4 Master's_______ Doctorial friend none Demonstration No Pref.

(circle all that apply)

Section II) BASIC PATIENT SAFETY NEEDS Priority H=High, M=Medium, L=Low

Initiated by _____________ Date_____ H M L Initiated by _________ Date________ H M L Initiated by _________ Date___ H M L

Priority change Date_______ Initials_ H M L Priority change Date_______ Initials_ H M L Priority change Date_______ In H M L

Interventions: Interventions: Interventions:

P&P CP3012

-Score =/>15 & pediatrics(13 & und

Teaching Method Response Date/Initial Teaching Method Response Date/Initial -green armband -observe Q1

Pt Ed Hndbk P/F Scale 0-10 P/F -bed alarm activated -up with ass

Orient to Rm P/F Managemen 1 2 3 4 P/F -BRP Q4hr, & Q2hr if incontinent/dia

Call light P/F Rx: 1 2 3 4 P/F -half side rails up -pt/family tea

MCM Guide P/F Rx: 1 2 3 4 P/F -care with pain meds & sedatives

Desired Outcome (Goals) Goal Met Desired Outcome (Goals) Goal Met

Y N Y N

Y N Y N

__Verbalize Pre/Intra/Post Surgical Pl Y N __ Pain relief with medication Y N

Plan if not Met: ________________________________Plan if not Met: ______________________________Teaching Method Response Date/Initial

Resolved by ________________ Date _________ Resolved by ________________ Date _________Name/DOB P/F

Fall Risk P/F

Initiated by _______________ Date___ H M L Initiated by _________ Date________ H M L Med Recon P/F

Priority change Date_______ Initials_ H M L Priority change Date_______ Initials_ H M L Stop Smoke P/F

Interventions: 1 2 3 4 P/F

1 2 3 4 P/F

specific/culturaly acceptable interventions Desired outcomes (Goals) Goal Met

Y N

Y N

Y N

Plan if not Met: ________________________

Teaching Method Response Date/Initial Teaching Method Response Date/Initial Resolved by _____________ Date _______

Wash Hands P/F Interpreter 1 2 3 4 P/F LEGENDIsolation 1 2 3 4 P/F Com Board 1 2 3 4 P/F complete upon admiscomplete at disch

S/S Infection 1 2 3 4 P/F 1 2 3 4 P/F Method:

Desired outcome (Goal) Goal Met Desired outcome (Goals) Goal Met

__No S/S of infection Y N Y N Response:

__TPR within normal limits for patien Y N __Verbalizes understanding of all te Y N

__No redness/drainage wound/inserti Y N _ ______________________ Y N

Plan if not Met: ________________________________Plan if not Met: ______________________________

Resolved by ________________ Date _________ Resolved by ________________ Date _________


patient label

Educational Level:(circle highest grade completed)

Interested

UninterestedBarriers Speech/Language________________ Visual Hearing Cultural/Religious Cognitive Emotional

Educational Level Literacy Financial Pain Physical Medical Equipment Denial

1. FOCUS: KNOWLEDGE DEFICIT 2. FOCUS: COMFORT/PAIN 3. FOCUS: SAFETY

Provide for priva

Provide patient education handbook Assess and meet personal need Identify patient by name & DOB P&PA

Provide MCM patient visitor guide Assess pain every shift and PRN Visual assessment as per policy

Orient to room and hospital environment Utilize appropriate pain scale Maintain JCAHO Safety Goals

Instruct on call light use Use alternative therapies for pain relief Fall risk appraisal (ADM, Daily, Condi

Instruct on phone use & room telephone n Assess pain medication effectiveness -Score


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pg 1 o

INTERDISCIPLINARY PLAN OF CARE AND PATIENT EDUCATION RECORD pg 2 of 5Section III) PATIENT PHYSIOLOGICAL & SUPPORT NEEDS Priority H=High, M=Medium, L=L

6. FOCUS SKIN INTEGRITY 7. FOCUS: RESPIRATORY 8. FOCUS: CARDIAC FUNCTION

Initiated by _______________ Date___ H M L Initiated by _______________ Date__ H M L Initiated by _______________ D H M

Priority change Date_______ Initials_ H M L Priority change Date_______ Initials_ H M L Priority change Date_______ In H M


& PRN, Routine: M/S tid, ICU Q1hr, P

ER/WC/Surg Sxs per patient conditio

Teaching Method Response Date/Initial Teaching Method Response Date/Initial Teaching Method ResponseDate/In

Drsng chngs 1 2 3 4 P/F O2/nebs 1 2 3 4 P/F S/Sangina 1 2 3 4 P/F

Waffle mattre 1 2 3 4 P/F S/S VAP 1 2 3 4 P/F Warning MI 1 2 3 4 P/F

1 2 3 4 P/F CDB, Insp Q1h 1 2 3 4 P/F Rx 1 2 3 4 P/F

1 2 3 4 P/F MDI 1 2 3 4 P/F Rx 1 2 3 4 P/F

Desired outcome (Goals) Goal Met Desired outcomes (Goals) Goal Met Desired outcomes (Goals) Goal M

__No or improved existing skin break Y N __Patent airway Y N __BP & P WNL for patient Y N

__No S/S of infection Y N __ABG/O2 Sats WNL Y N __Optimal C.O./function for pat Y N

__Surgical wound healing w/o compli Y N __Bilateral breath sounds clear Y N __Decrease in ectopy dysrhyth Y N

__Verbalize understanding/demonstr Y N __Improved cough, airway clearing Y N __Verbalizes understanding of Y N

Plan if not Met: ________________________________Plan if not Met: ______________________________ Plan if not Met: ______________________

Resolved by ________________ Date _________ Resolved by ________________ Date _________ Resolved by ________________ Date _

9. FOCUS: IMMOBILITY(Musc/Skeletal)



Interventions: Interventions: Medication review:

Interventions:


Assist Device 1 2 3 4 P/F IV therapy 1 2 3 4 P/F I & O 1 2 3 4 P/F

1 2 3 4 P/F 1 2 3 4 P/F 1 2 3 4 P/F

Desired outcome (Goal) Goal Met Desired outcome (Goal) Goal Met Desired outcome (Goal) Goal M

__No complications related to immob Y N __Fluid Intake adequate/ouput WNL Y N __No adverse drug events Y N

__No decrease in ROM/Activity as tol Y N __VS &hemodynamics stable/labs W Y N __Verbalizes understanding of Y N

Plan if not Met: ________________________________Plan if not Met: ______________________________ Plan if not Met: ______________________

Resolved by ________________ Date _________ Resolved by ________________ Date _________ Resolved by ________________ Date _12. FOCUS: ELIMINATION/CONSTIPATION 13. FOCUS: GASTROINTESTINAL 14. FOCUS: NUTRITION



Interventions: Interventions:


1 2 3 4 P/F 1 2 3 4 P/F lo Na/lo ch 1 2 3 4 P/F

1 2 3 4 P/F 1 2 3 4 P/F 1 2 3 4 P/F

Desired outcome (Goals) Goal Met Desired outcomes (Goals) Goal Met Desired outcome (Goals) Goal M

Dietician consult

Implement protocol for Braden


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__Verbalizes understanding bowel pr Y N __No c/o nausea, vomiting, diarrhea Y N __Weight maintain/loss/gain ne Y N

__Bowel sounds present/soft formed Y N __Hemodynamically stable/no s/s GI Y N __Nutritional/healing needs me Y N

Plan if not Met: ________________________________Plan if not Met: ______________________________ Plan if not Met: _______________________

Resolved by ________________ Date _________ Resolved by ________________ Date _________ Resolved by ________________ Date __

INTERDISCIPLINARY PLAN OF CARE AND PATIENT EDUCATION RECORD pg 3 of 5Section III) PATIENT PHYSIOLOGICAL & SUPPORT NEEDS Priority H=High, M=Medium, L=Lo

15.FOCUS: PERIPHERAL VASCULAR 17.FOCUS: ENDOCRINE 16.FOCUS: NEUROLOGICAL

Initiated by _______________ Date___ H M L Initiated by _______________ Date__ H M L Initiated by _______________ D H M L

Priority change Date_______ Initials_ H M L Priority change Date_______ Initials_ H M L Priority change Date_______ Ini H M L


`

lab values/vit neuro checks, critical values.

Teaching Method Response Date/Initial Teaching Method Response Date/Initial Teaching Method ResponseDate/Init

keep ext warm 1 2 3 4 P/F DM dx process 1 2 3 4 P/F Warning CVA 1 2 3 4 P/F

1 2 3 4 P/F Glucometer 1 2 3 4 P/F 1 2 3 4 P/F

1 2 3 4 P/F 1 2 3 4 P/F 1 2 3 4 P/F

Desired outcome (Goal) Goal Met Desired outcomes (Goals) Goal Met Desired outcomes (Goals) Goal M

__Skin W/D with capillary refill


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1 2 3 4 P/F 1 2 3 4 P/F


patient label

INTERDISCIPLINARY PLAN OF CARE AND PATIENT EDUCATION RECORD pg 4 of 5

Adm Dx:

Focus: Radiology

Date Sched Focus: Radiology

Date Sched Focus: Nuc Med

Date Sch

__/__correct pt__/__correct prep__/__cor

Focus: Radiology Date Sched Handoff Communication Detail Focus: Other Date Sched

Support Needs Situation/Procedure:

Personal Needs

_____________________

Safety Needs

IR PT___ INR____ PTT____ date_____

Physical Needs: Transport Via

______________

Handoff Communication Detail

Focus In-House Transfer Focus In-House Transfer Focus In-House Transfer

(circle as appropriate) (circle as appropriate

RF DM GI Bleed CP CVA ________________ RF DM GI Bleed CP CVA _______________ RF DM GI Bleed CP CVA _________

TPR________ B/P_____ TPR________ B/P_____ TPR________ B/P_____

LBM______ IV site________ Fld________ rate____mlLBM______ IV site________ Fld________ rate____ LBM_____ IV site______ Fld_______ rate__

A&O X ____ incont fole Skin:_______ A&O X ____ incont fole Skin:_______ A&O X ____ incont folSkin:_______

Q&A Q&A Q&A

Orders Orders Orders

Date__________ Initials From_______ To______ Date__________ Initials From_______ To______ Date__________ Initials From_______ To_

Teaching Method Response Date/Initial Teaching Method Response Date/Initial LEGENDcontrast dye 1 2 3 4 P/F 1 2 3 4 P/F complete upon admiscomplete at disch

MRI 1 2 3 4 P/F 1 2 3 4 P/F Method:

CT scan 1 2 3 4 P/F 1 2 3 4 P/F

D=Verbalizes UnderstandingC=Denial/Resis

Teaching Goals: P or F is able

Section IV) SUPPORT & Handoff Communication (SBAR Methodology) S/B=nurse A=nurse/tech R=tech

Allergic to contrast dye: ___Yes ___No Use for:procedure off unit/req.prep/traumatic/Inh

Situation/Procedure: with contrast Situation/Procedure: with contrast Situation/Cardiac Stress TestCTMRI : head abd_______ ______________ CTMRI : head abd_______ ______________ Adenosine/thallium Dobutaine/thalliu

Sono(US): R/LLE abd_____ _____________ Sono(US): R/LLE abd_____ _____________ Persantine/thallium _____________

UGI LGI(BE) Hypaque _____________ UGI LGI(BE) Hypaque _____________ Exercise (not a nuc med scan

Background:(Hx r/t situation/presenting symp Background:(Hx r/t situation/presenting sym Background: Cardiac Hx/symptomspain____ LOC Trauma _____________ pain____ LOC Trauma _____________ CP MI Stents/CVI CABG______

claustrophobia/anxiety P re-Med w/__________claustrophobia/anxiety P re-Med w/_________Surgical Clearance _________________

x MRI:ICD prosthesis


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Colon Prep 1 2 3 4 P/F 1 2 3 4 P/F

Stress Trest 1 2 3 4 P/F 1 2 3 4 P/F



patient label

INTERDISCIPLINARY PLAN OF CARE AND PATIENT EDUCATION RECORD pg 5 of 5

Section V) PATIENT AGE SPECIFIC CARE NEEDS Initial Box Representing the Patient's Care Need

=Patient F=Famil

A=Asked questions= Return Demonstrates

B=Poor AttentionN=Needs Reinforcement

D=Verbalizes UnderstandingC=Denial/Resist

Teaching Goals: P or F is able t


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patient label


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A) The Basics

1) Read these instructions before attempting to complete this form to ensure2) Place a patient label in the spaces on the bottom right corner of the pages indicated.

3) There is a legend located on the bottom right corner of pages 1, 3, 4, and the addendum page for your

shading are required at admission, areas of light-gray shading are required at discharge on any

Select the Focuses for which the patient requires intervention and teaching this admission: Initia

and dating next to "initiated by:" select priority H=high, M=Medium, L=low, Select appropriate i

At discharge each focus are that has been initiated must be resolved, cirlde Y=Yes indicating go

is true. Circle N=No if it is false and next to "plan if not met" write what the follow-up plan is: "N

are responsible that the patient/caregiver receives the education necessary to manage their car

Interventions to relieve symptoms, Procedures (ambulatory devices, equipment, wound care etc

of Refusal of care, etc. Educational items that are required or are frequently used have been ad

then (see legend) circle method, patient and or family, add the letter(s) that describe the patien

the communication to ensure patient safety when the patient is off of the unit and out of the car

i) radiology exams off unit that requiring preps, these require safisticated communication betweii) in house transfers from any unit to any other unit: since care and charge nurses are changing

should document on the form as appropriate for that disciplines interventions, education etc. Ea

place your initials, signature and date at the bottom of the form in the indicated box. (on one p

B) Section I Patient Educational Needs Assessment Section (page 1) & Section V Age Specific

1) Complete at the time of admission with the Admission Assessment (M/S admit nurse, ICU/PCU/ER hold p

responses for each topic. Page 5 initial the box in the focus section appropriate for the patient, c

2) Readiness to learn: circle either "interested" or "uninterested" as appropriate, if there are any barriers t

circle all baariers the patinet/family has, next to Speech/Language indicate primary language, or

C) Section II Basic Patient Safety Needs

1) The areas with the patterned shading are required to be completed upon admission. On Focus 1 indicat2) Each of these focuses are basic care needs. Focuses 1-5 contain some interventions basic to all patient'

3) Teaching should be done as indicated by the pattern shaded areas upon admission by circling method,

letter(s) that describe the patient's/famiDocument any other teacing done.

5) Focus 3 Safety contains the fall risk interventions, if the score is =/>15 ALL interventions Must be initia

D) Section III Patient Physiological and Support Needs

1) Select the appropriate Focuses the correspond to the primary diagnosis, other diagnoses/care issues re

3) Pharmacy and Discharge Planning are responsible for their Focus areas.

E) Discharges (solid gray shaded areas)1) The primary care nurse assigned to the patient at discharge is required as part of discharge documenta

F) Update Daily:

1) Review each focus initiated and if any issues are resolved indicate by circling Goal Met "Y=Yes" (note f

2) Add new focus areas: use assessment, added medications, test results and new consults as suggetions

3) Change the priority level according to patient needs by initialing/dating/circling new priority level next t

G) Section IV Patient Support and Handoff Communication Needs

S=Situation, B=Background, and teahing of the proedure and any prep (hand out "radiology exa

A=Assessment will have lab value added as indicated, and at the time the patient is taken to ra

correct pt/prep/test, the radiology tech will initial the same when pt is in department before the

Instructions: INTERDISCIPLINARY CARE PLAN & PATIENT/FAMILY ED

4) The care plan is required to be initiated upon admission and updated and daily by various regulatory

5) This form combines three required sets of documentation:

a) an interdisciplinary plan of care: guides the care based on the focus(health and care issu

standards (standards of care are what a reasonable and prudent professional is accountable to d

b) an interdisciplinary patient/family education record: ALL education should be docume

c) a hand off communication tool/record: this is located on page 4 and on the addendum pa

iii) situations meeting the statement in "5c". (handoff communication during change of shift, pre

6) This form is interdisciplinary (all disciplines: Nursing/PT/SLP/RT/Dietician/Rx/Case Management/Social

goals have been preselected and represent MCM basic standards of care. Select other interventi

check the indicated box, and these patients are high risk for falling

teaching. Fill out each section as indicated in A5a above.2) Document all teaching done, add items as needed as indicated in A5b above there are extra teaching

with the acception of pharmacy and discharge planning. See A5b above.

1) Radiology/Nuc Med/Other: For the types of procedures described in A5c above the care/charge nurse


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filled out before the patient returns to floor as indicated, the tech will initial and date, and fill ou

2) In House Transfer all sections will be filled out by transfering nurse, when the patient arrives at new uni


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roper completion

convenience. Areas of patterned

ocus initiated.

te the appropriate focuses by initialing

nterventions/goals. /

als met if the Goal statement

to___" D/c to LTAC" etc.

e including: Diagnosis, Medications,

), Diet, Plan of Care, Consequences

ed for you, add others as needed

t's/family's response, date & initial

e of the primary/charge nurse. Such as:

en disciplines

ch time YOU document on the form

ge is all that is necessary)

are Needs (page 5)

rimary nurse) by circling appropriate

omplete signature box at bottom.

o learning please circle "barriers" and

things like aphasic.

e primary diagnosis.s care needs. These interventions and

patient and or family, add the

ed. If the patient requires restraints

quiring significant interventions and

tion to resolve each Focus area

cus 1-5 are NOT resolved until D/C.

for changes to the plan.

o "Priotity change"

ms"under procedures on Z-drive)

iology the care/charge nurse initials

procedure. R=Rcommendation will be

UCATION RECORD

agencies. Nursing is responsible.

s) and each disciplines intervention

o based on liscensure & training)

ted in the "teaching" sections. YOU

ge. This document encompasses

-post procedures are NOT done here)

Work etc.) involved in the case

ons and goals as needed. See A5a

slots at the bottom of page 3

ssigned to the patient will document


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signaure section at bottom of page.

t both nurses will initial as indicated.


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INTERDISCIPLINARY PLAN OF CARE

CASE CONFERENCE RECORDDATE:______________________ ANTICIPATED DISCHARGE DATE:________________________

NEED AREA TREATMENT PLAN VARIANCES DISCHARGE PLA

Discharge Outcome Return to:_______________ Unable to return

Needs

Support

Needs

Personal

Admit Needs

ATTENDING: Safety

CM SW NURSING Needs

REHAB CARDIOPULM

DIETICIAN RX Physical

PHYSICIAN Needs


patient label


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INTERDISCIPLINARY PLAN OF CARE AND PATIENT EDUCATION RECORD ADDENDUM

Adm Dx:

Focus: Radiology Date Sched Focus: Radiology Date Sched Focus: Nuc Med Date Sch

__/__correct pt__/__correct prep__/__cor

Focus: Other Date Sched Focus: Other Date Sched Focus: Other Date Sched

Situation/Procedure:

Assessment: Assessment:

initial/date initial/date initial/date

Focus In-House Transfer Focus In-House Transfer Focus: Other

(circle as appropriate) (circle as appropriate)

RF DM GI Bleed CP CVA ________________RF DM GI Bleed CP CVA __________________

TPR________ B/P_____ TPR________ B/P_____

LBM______ IV site________ Fld________ rate____mLBM______ IV site________ Fld________ rate____ml/hr

A&O X ____ incont fole Skin:_______ A&O X ____ incont fole Skin:_______

Q&A Q&A Q&A

Orders Orders

Date__________ Initials From_______ To______ Date__________ Initials From_______ To______ initial/date

Teaching Method Response Date/InitialTeaching Method Response Date/Initial LEGEND ADDENDUcontrast dye 1 2 3 4 P/F 1 2 3 4 P/F complete upon admicomplete at discha

MRI 1 2 3 4 P/F 1 2 3 4 P/F Method:

CT scan 1 2 3 4 P/F 1 2 3 4 P/F


Colon Prep 1 2 3 4 P/F 1 2 3 4 P/F

Stress Trest 1 2 3 4 P/F 1 2 3 4 P/F



Section IV) SUPPORT & Handoff Communication (SBAR Methodology) S/B=nurse A=nurse/tech R=tech

Allergic to contrast dye: ___Yes ___No Use for:procedure off unit/req.prep/traumatic/In

Situation/Procedure: with contrast Situation/Procedure: with contrast Situation/Cardiac Stress TestCTMRI : head abd_______ ______________ CTMRI : head abd_______ ______________ Adenosine/thallium Dobutaine/thalliu

Sono(US): R/LLE abd_____ _____________ Sono(US): R/LLE abd_____ _____________ Persantine/thallium _____________

UGI LGI(BE) Hypaque _____________ UGI LGI(BE) Hypaque _____________ Exercise (not a nuc med scan

Background:(Hx r/t situation/presenting sympBackground:(Hx r/t situation/presenting sympBackground: Cardiac Hx/symptomspain____ LOC Trauma _____________ pain____ LOC Trauma _____________ CP MI Stents/CVI CABG______

claustrophobia/anxiety P re-Med w/_________ claustrophobia/anxiety P re-Med w/_________ Surgical Clearance _________________

x MRI:ICD prosthesis


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patient label


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ct test

e

use Transfe

hr

__

__

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e)

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Interdisciplinary Plan of Care and Patient Education

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